1 The issue
Fluoridation of water is the process of artificially adjusting the natural fluoride content of drinking water in order to reduce the incidence of tooth decay. This is seen by some publichealth experts as an efficient way of tackling tooth decay in children and reducing healthinequalities.
Fluoride is adjusted up to around 1.0mg/l, which is the recommended level of artificialfluoridation for drinking water to help prevent dental caries, particularly in children. Similar levels of fluoride are naturally found in drinking water in some areas of Britain.Fluoridation was first proposed in the late 1930s and introduced to North America in 1945. Itwas introduced to Britain as part of an experimental programme in 1955 before beingintroduced more widely in the 1960s.The safety and efficacy of fluoridation has been under almost constant review since it wasfirst proposed. Both pro and anti-fluoridation campaigners cite extensive and contradictoryscientific evidence and court judgements to support their arguments. It has been remarkedthat only smoking has been more extensively researched than fluoride.
The EC drinking water directive (Directive 80/778/EEC) sets a level of 1.5mg/l for fluoride indrinking water. This is in line with the WHO guideline which represents a concentration which
“does not result in any significant risk to the health of the consumer over a lifet
consumption”. The WHO guidelines however do caution that concentrations above this value
carry an increasing risk of dental fluorosis (cosmetic damage to tooth enamel), and much higher levels lead to skeletal fluorosis
(damage to the joints and bones and more serious damage toteeth).
Fluoridation is seen, by those who support it, as a safe and effective means of reducinghealth inequalities and sparing many children the need to undergo teeth extraction with theassociated administration of anaesthetic.Those who oppose water fluoridation are concerned about the potential health impacts andthey have some ethical objections.
1.1 How widespread is fluoridation?
In the UK around 6 million people receive naturally and artificially fluoridated water:
In the UK, around half a million people receive naturally fluoridated water. A further 5.5million receive water which has been artificially fluoridated at, or around, the optimum
British Medical Association, Fluoridation of water, 12 January 2010, www.bma.org.uk
Meeting of the All-Party, Water group,
Fluoridation of Water Supplies
, 10 February 1998. Comment by Dr NoelOlsen, Chairman of the UK Public Health Medicine Consultative Committee for the British Medical Association.
Library Research Paper 93/121, p 10